Premature Infant
Considerations
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Altered airway anatomy
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Other physiologic derangements of prematurity:
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Pulmonary: respiratory distress syndrome, bronchopulmonary dysplasia, rapid desaturaiton, post-op apnea, persistent pulmonary hypertension
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Cardiovascular: HR/preload dependant cardiac output, transitional circulation/PDA, bradycadia, congenital heart disease
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CNS: intraventricular hemorrhage, seizures, retinopathy of prematurity, apnea
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GI: GERD, NEC
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Metabolic: Impaired temperature & glucose regulation
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Hematology: anemia, thrombocytopenia
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Altered pharmacology:
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↑ volume of distribution
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Opioid sensitivity
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↓ clearance, protein binding, metabolism, ↓ MAC
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Immature renal & hepatic function
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Difficult IV access
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Post op apnea monitoring
Goals
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Ensure optimization of multisystem derangements including respiratory, cardiovascular, hepatic, renal, hematological
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Anticipate fluid, electrolyte, glucose derangements, & optimize preoperatively
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Ensure continuous temperature monitoring & maintain normothermia